Other factors: Having high blood pressure or having had diabetes during pregnancy or delivering a baby weighing 9 pounds or more

TESTS TO DETECT

The Centers for Disease Control and Prevention says people with pre-diabetes are up to 15 times more likely to develop type 2 diabetes than people who have normal blood sugar levels. Pre-diabetes is a condition in which blood sugar level is higher than normal. It can be called by other names, depending on the test used to detect it:

• An oral glucose tolerance test is one in which the patient drinks 75 grams of glucose (sugar) and blood is tested two hours later. Pre-diabetes, also called impaired glucose tolerance, is diagnosed if the reading is 140 to 199 mg/dL (milligrams per deciliter).

• A fasting plasma glucose test is a blood test taken after eight hours of not eating. Pre-diabetes, also called impaired fasting glucose, is diagnosed if the reading is between 100-125 mg/dL.

Ed Chandler, 53, a commercial mortgage banker in Indianapolis, has always been competitive and athletic.

"I always had a life philosophy of developing my mind and body at the same time," he says.

But a couple of years ago, he got some news that nearly knocked him off his game. He found out that, like 54 million Americans, he was heading for type 2 diabetes. He has "pre-diabetes," a condition in which his blood sugar levels are higher than normal, but not quite high enough to be diagnosed as diabetes.

Chandler, whose grandfather had diabetes and whose father, 80, developed it in his 60s, is not about to sit around and let it happen to him.

He is taking part in an Indiana University pilot program — being tested at five YMCAs in Indianapolis — aimed at preventing or delaying diabetes in people with pre-diabetes.

Once he got with the program, he says, "I started getting more exercise and started feeling better. I chose to rebalance my life."

He has always been active. "I'm one of those baby boomers in the running generation," he says, and as he got older, he added bicycling to his activities.

But he likes to eat, too, and over the years, he got up to about 235 pounds on his 5-foot, 11-inch frame. "It was just a function of me not paying attention to what I was doing," he says. "Men tend to go out and eat and drink too much. You're in the business world. You've got to have steak and drink beer and have scotches and martinis."

Turning his lifestyle around

Now, he's focused. "Some people who are pre-diabetic don't realize what they're doing, and my habits were not good for me. So, for the last two years, I haven't eaten much red meat, I don't go to fast-food restaurants except to get coffee, I don't eat fried foods too much, I eat a lot of chicken and fish, and write down every day what I eat. That's the best way: Write it down and don't cheat. If you cheat, you're cheating yourself out of the last five or six years of your life."

The program is a series of 16-week classes for groups of 10-12 people, who put into action the lessons learned in a large study called the Diabetes Prevention Program, or DPP. Published in 2002, the DPP found that people who have pre-diabetes can reduce their risk of developing the disease by as much as 58% if they lose 5% to 10% of their body weight and exercise about half an hour a day.

"If you have a chance of avoiding a disease like this by changing your lifestyle, that's pretty good odds," Chandler says.

The idea of the YMCA program, which could provide a model for use in Y's nationwide, is simply that "it's better to catch the horse before it gets out of the barn," says IU diabetes researcher David Marrero, who helped develop the program. "Diabetes is reaching epidemic proportions. The number of people who have early stages — pre-diabetes — is three to four times the people with frank diagnoses of diabetes." The Centers for Disease Control and Prevention says 14.6 million people have been diagnosed with diabetes, and an additional 6.2 million have it but don't know it.

A slap in the face

If people know their risk, they can take steps to head it off, Marrero says. Some risks can't be changed, such as age, race, a history of diabetes during pregnancy or a genetic predisposition for diabetes. But "if you're heavy and inactive, the risk of diabetes goes up significantly," he says. "Weight is controllable by you. I'm not saying it's easily controllable, but you can change it."

Chandler echoes that. Keeping weight off is a daily challenge, and he admits to occasional dietary lapses. "I go off the wagon and have things I call devil food," he says. "Potato chips. Ice cream. I don't eat hamburgers anymore. I can't do it. I'm like an alcoholic."

Obesity is a factor in type 2 diabetes because of the balance between the supply of insulin and the body's demand for it, says endocrinologist John Buse, president of the American Diabetes Association.

Insulin, produced in the pancreas, helps blood sugar get into the cells, where it is used for energy. As body size increases, the pancreas churns out more insulin, but eventually, it can't keep up with demand, and sugar levels build up in the blood.

Most people with type 2 diabetes have the body of an SUV but the pancreas of a small sedan, Buse says. "If they shrunk their frame, their pancreas would be just fine."

By getting fit, losing weight and reducing stress, people can use insulin more efficiently, he says, and they'll feel the difference. "I have patients tell me that they believe they're healthier for having been diagnosed with diabetes," Buse says. "If they hadn't been slapped in the face, they'd never have taken control, reduced their weight and increased their exercise."

For Chandler, it took just the awareness of his high risk for developing diabetes in the future to change his unhealthy habits. His weight is down to 200 pounds, and he's aiming for 190 by the end of the year.

"I'm just one guy trying to make sense out of a problem I've got and trying to enjoy life," he says.

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Ed Chandler has some oatmeal at a restaurant before work. Chandler tries to keep "devil food" - like chips, ice cream, hamburgers - out of his diet.

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